Internal barriers, external barriers, and bullying experiences among trans people in sport and fitness settings: associations with psychological distress and suicidality

Background: Common and unique experiences of internal barriers (e.g. feeling anxious about others reactions), external barriers (e.g. inadequate bathroom/changing facilities), and gender-based bullying (e.g. from venue staff, other patrons, team members) have been observed among trans and gender diverse (trans) people in sport and fitness settings though little research has considered the potentially deleterious mental health outcomes associated with these experiences. Methods: Data was derived from a national, online cross-sectional survey of trans people aged ≥16 years, currently living in Australia open between February and April 2023. Multivariate logistic regression models and postestimation orthogonal polynomial contrasts tested (dose-response) associations between sport and fitness-specific internal barriers, external barriers, and bullying experiences with mental health (past 30-day psychological distress; past 12-month self-harm and suicidal thoughts and behaviors), controlling for age and gender. Results: Non-binary respondents reported the highest average number of internal barriers, external barriers, and bullying experiences relative to trans men and trans women. Trans people who reported ever being bullied or excluded based on their gender by sports team members and parents/guardians of other team members reported between 5.5 to 8.4 times increased odds of reporting a suicide attempt in the preceding 12 months, regardless of age and gender. Levels of psychological distress proportionately increased with the number of internal barriers, external barriers, and bullying episodes experienced by participants, each in a dose-response fashion. Conclusions: Internal barriers, external barriers, and bullying experiences, commonly and uniquely faced by trans people in sport and fitness settings are significantly associated with increased levels of psychological distress and odds of self-harm and suicidality. Strategies to promote inclusion of trans people, particularly non-binary people, should be considered by sport and fitness organizations, especially when making policies for the inclusion of trans people in elite and community-level sport. Keywords: Trans; gender diverse; sport; physical activity; mental health.